Self-Reported Disability Type and Risk of Alcohol-Induced Death – A Longitudinal Study Using Nationally Representative Data

Abstract

Background Disability is associated with alcohol misuse and drug overdose death, however, its association with alcohol-induced death remains understudied. Objective To quantify the risk of alcohol-induced death among adults with different types of disabilities in a nationally representative longitudinal sample of US adults. Methods Persons with disabilities were identified among participants ages 18 or older in the Mortality Disparities in American Communities (MDAC) study (n = 3,324,000). Baseline data were collected in 2008 and mortality outcomes were ascertained through 2019 using the National Death Index. Adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) were estimated for the association between disability type and alcohol-induced death, controlling for demographic and socioeconomic covariates. Results During a maximum of 12 years of follow-up, 4000 alcohol-induced deaths occurred in the study population. In descending order, the following disability types displayed the greatest risk of alcohol-induced death (compared to adults without disability): complex activity limitation (aHR = 1.7; 95% CI = 1.3–2.3), vision limitation (aHR = 1.6; 95% CI = 1.2–2.0), mobility limitation (aHR = 1.4; 95% CI = 1.3–1.7), ≥2 limitations (aHR = 1.4; 95% CI = 1.3–1.6), cognitive limitation (aHR = 1.2; 95% CI = 1.0–1.4), and hearing limitation (aHR = 1.0; 95% CI = 0.9–1.3). Conclusions The risk of alcohol-induced death varies considerably by disability type. Efforts to prevent alcohol-induced deaths should be tailored to meet the needs of the highest-risk groups, including adults with complex activity (i.e., activities of daily living – “ALDs”), vision, mobility, and ≥2 limitations. Early diagnosis and treatment of alcohol use disorder within these populations, and improved access to educational and occupational opportunities, should be considered as prevention strategies for alcohol-induced deaths.